Website Perks HR
JOB DESCRIPTION:
Purpose of the Role
The Senior Manager – Claims is responsible for overseeing and monitoring claims evaluation and payments for both network and non-network hospitals, ensuring compliance with SLAs and SOPs, timely settlement for clients and service providers, effective utilization control, and minimization of loss ratio.
Key Responsibilities
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Supervise evaluation of network and non-network claims in line with approved SLAs and SOPs.
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Identify and prevent overpayments or undue payments to service providers.
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Highlight and address areas of concern related to claims settlement between service providers and HID.
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Resolve day-to-day operational issues within the claims department efficiently.
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Assist in monitoring team workflow, productivity, target achievement, and completion of objectives.
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Ensure timely and accurate preparation of monthly, quarterly, and annual claims ratio reports.
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Coordinate closely with internal teams, branches, and external stakeholders to ensure smooth claims operations.
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Perform any other tasks as assigned by management within defined timelines.
Requirements
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Education: MBBS
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Experience: 8–10 years of relevant experience
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Industry: Insurance (Health Claims preferred)
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Skills:
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Health insurance claims management
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Claims evaluation & utilization control
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Strong analytical and reporting skills
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Behavioral Competencies:
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Strong leadership and people management skills
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Problem-solving and decision-making ability
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Effective communication and coordination
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